Cyclospora Cases Are Rising: What Older Adults Need to Know
If you’ve been watching the news lately, you may have heard about the latest cyclosporiasis outbreak. According to the Centers for Disease Control and Prevention (CDC), 1,644 confirmed Cyclospora infections have been linked to an outbreak associated with shredded iceberg lettuce served at Taco Bell locations in five states (Indiana, Kentucky, Michigan, Ohio and West Virginia), resulting in 94 hospitalizations. The investigation continues and other sources may be identified.
Cyclosporiasis is the illness caused by the parasite Cyclospora cayetanensis (sometimes referred to as Cyclospora). Unlike a regular stomach bug, cyclosporiasis can linger for weeks without prompt treatment. While anyone can get cyclosporiasis, older adults are more susceptible to serious illness, making it especially important to recognize symptoms early and know when to seek medical attention.
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As cases continue to rise, some public health experts have questioned whether recent staffing reductions and other changes across the USDA and FDA could have affected food safety oversight. However, there is currently no evidence that any specific policy change contributed to the current outbreak, which remains under investigation.
What Is Cyclosporiasis — and Why Are Older Adults at Greater Risk?
Cyclosporiasis is a parasitic infection that spreads from contaminated water or food — not from person to person. It is commonly linked to foods like cilantro, basil, romaine, berries, snow peas, and imported fresh produce.
“Symptoms include watery, foul-smelling diarrhea, cramping, bloating, nausea, and loss of appetite,” explains Heather Swanson, MD, Regional Medical Officer at CareMore Health. “Some may have low-grade fever and vomiting.”
Symptoms tend to be more severe in older adults, young children, and people with weakened immune systems. “Older adults are at higher risk of hospitalization and may develop more severe symptoms, particularly profound fatigue, weight loss, and dehydration,” Dr. Swanson says.
Signs of dehydration include:
- Decreased urination
- Dark urine
- Lightheadedness when standing
- Dry mouth
- Confusion
- Rapid heartbeat
“Fatigue is a prominent symptom in three-quarters of cases in the older population and can be quite debilitating,” she adds.
If you notice any of these symptoms, contact your healthcare provider for support.
““Older adults are at higher risk of hospitalization and may develop more severe symptoms, particularly profound fatigue, weight loss, and dehydration.”
Heather Swanson, MD, Regional Medical Officer at CareMore Health
How Is It Different from a Stomach Bug?
While cyclosporiasis is fairly similar to a stomach bug, there are a few important differences:
Typical stomach virus
- Vomiting is more common
- Can be treated at home with rest and hydration
- Usually goes away within 2 to 3 days
Cyclosporiasis
- Watery diarrhea
- Cramping
- Bloating
- Foul-smelling stools
- Symptoms improve then return
- Requires specific prescription antibiotics
- Can last for several weeks
“[Cyclosporiasis] has a characteristic waxing and waning pattern – patients feel better for a day or two, then relapse,” Dr. Swanson says.
Understanding the difference between the two conditions can help you determine when to contact your healthcare provider.
When Should You Call Your Doctor?
Contact your healthcare provider if you experience any of the following symptoms:
- Diarrhea lasting more than three days
- Inability to stay hydrated
- Confusion
- Dizziness
- Dark urine
- Rapid heartbeat
- Bloody diarrhea
- Severe abdominal pain
- Relapse after seeming to improve
For older adults specifically, Dr. Swanson recommends seeking urgent care for bloody diarrhea, right upper quadrant pain, and diarrhea that lasts more than three days or relapses after initial improvement.
Be sure to request specific testing for Cyclospora — routine stool tests don’t always include it. If you test positive for the parasitic infection, your healthcare provider will prescribe antibiotics to relieve symptoms.
Treatment and Recovery
Dr. Swanson says treatment for cyclosporiasis includes three components: antibiotics, aggressive rehydration, and early refeeding with well-tolerated foods.
“The antibiotic TMP-SMX is the definitive treatment for cyclosporiasis and typically resolves symptoms in 1 to 2 days,” she explains. “Patients may also use over-the-counter treatments such as loperamide or bismuth (Pepto-Bismol) to help with symptoms; however, these are not an alternative to antibiotics.”
She adds that replenishing fluids and electrolytes is important — especially for older adults who face a higher risk of dehydration. She recommends oral rehydration solutions (ORS) such as Pedialyte or CeraLyte.
Also, resume eating as soon as you can. Dr. Swanson recommends starting with well-tolerated foods like bananas, rice, applesauce, and toast. “You may want to avoid lactose-containing dairy for a period of time due to transient loss of the enzymes responsible for breaking down lactose,” she explains. “Avoid fatty, heavy, or spicy foods and caffeine as these can worsen cramping and diarrhea.”
How to Lower Your Risk This Summer
Dr. Swanson shares the following tips to reduce your risk of getting the parasitic infection:
- Wash your hands before and after handling fresh produce
- Be aware of higher-risk food items
- Stay up-to-date on the latest recalls and outbreak alerts
- Wash produce thoroughly
- Cook fresh produce thoroughly when possible
- Be cautious with imported fresh herbs and leafy greens
“The most important point to understand is that Cyclospora oocysts are resistant to standard chemical disinfectants used to process produce,” she says.
Bottom Line
Unlike the common stomach bug, prolonged diarrhea is not something to ignore. If your symptoms last more than a few days, contact your healthcare provider, stay hydrated, and ask whether testing for Cyclospora is appropriate.
Early diagnosis and treatment can considerably shorten the duration of the infection and reduce the risk of dehydration and other serious complications.
